Mobile Application Applied for Cognitive Rehabilitation: A Systematic Review

The COVID-19 pandemic has increased the demand for home rehabilitation services, leading to the development and rising demand for cognitive rehabilitation apps. However, a comprehensive analysis of the content and effectiveness of these apps is needed. This study systematically reviewed and analyzed the literature on mobile apps for cognitive rehabilitation. One researcher and an external expert conducted the study selection, data extraction, and quality assessment following the PRISMA Checklist 2020 guidelines. Our review of 18 studies identified 8 randomized controlled trials (RCTs) (44.44%) of high quality and 10 non-RCT studies (55.56%) of moderate quality. Overall, 16 of the 18 studies (88.88%) demonstrated positive clinical implications for cognitive function after using cognitive rehabilitation apps. Eight studies showed a correlation between app use and improved cognitive function, and four highlighted the potential for cognitive function evaluation through apps. All studies employed various occupational therapy (OT) intervention approaches, with prevention being the most common (100%), followed by establishment and restoration (83.33%), maintenance (77.77%), and creation and promotion (38.88%). This study clinically validates the effectiveness of cognitive rehabilitation mobile applications from an occupational therapy perspective.


Introduction
As society ages, the prevalence of geriatric diseases, such as dementia, mild cognitive impairment, and stroke, is increasing.Consequently, the number of people with cognitive disabilities is steadily rising [1][2][3].Many researchers have emphasized the importance of cognitive rehabilitation in reducing behavioral and cognitive consequences and promoting independence and quality of life [4][5][6].The need to adapt the healthcare system to meet these emerging needs and ensure continuity of care is evident [7].Moreover, during the COVID-19 pandemic, the potential of using innovative technologies to provide healthcare services at home has been emphasized [8][9][10].Technology's ubiquity, even among older adults, has led to the development of numerous smartphone and web-based applications (apps) designed to assist individuals with mild cognitive impairment (MCI).Within cognitive training and stimulation, studies have identified promising strategies for preserving cognitive function in healthy older adults and individuals with MCI [11].Previous studies on cognitive training game applications have shown that smartphone game applications can diagnose, prevent, and alleviate dementia [12] and that cognitive stimulation-based applications have been applied to the elderly to prove their effectiveness in enhancing cognitive function [13].
Recently, digital therapeutics using software such as mobile applications, games, virtual reality, and artificial intelligence have gained popularity [14], including in the field of cognitive training [15].Despite the growing popularity of mobile apps for cognitive training, there remains a need for more evidence regarding their effectiveness as digital therapeutics.Previous studies have analyzed the quality of mobile apps for conditions such as low back pain [16] and speech disorders [17].However, there is currently a lack

Search Strategy
Our search strategy, conducted through June 2022 and in line with the Cochrane Handbook for Systematic Reviews of Interventions, ensured we found the most relevant publications.We identified relevant studies published between January 2010 and June 2022 in the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using three clusters of applied keywords (cognition disorder, mobile applicationbased cognitive rehabilitation, and cognitive function) to guide our search (Table 1).

Study Selection
One researcher and one external expert conducted the study selection, data extraction, and quality assessment for this study.Two reviewers evaluated each of the selected studies according to the search procedure.Initially, the studies were selected based on the title and abstract according to the criteria presented in the PICO section.Disagreements about inclusion were resolved by consensus.The two reviewers then evaluated the full-text version of each included study and decided whether to include it in the review.Again, disagreements about inclusion were resolved by consensus.
Two reviewers who used the search method as their guide rated each of the chosen studies.The title and abstract were initially considered for selection based on the PICO section's criteria.A consensus was reached to settle differences in inclusion.The two reviewers examined the full-text versions of all the included studies and then decided whether to include them in the review.Once more, consensus overcame differences regarding inclusion.

Data Extraction Process
First, two reviewers performed data analysis, assessing the relevance of the review concerning the study questions and objectives.This was based on information from each study's title, abstract, and keywords.The following data were gathered from each study on a Microsoft Excel 365 spreadsheet: title, authors, year of publication, journal, country of the study, study design, type of intervention, subject characteristics (mean age, sex ratio), session frequency and duration, outcome measurement, results, effectiveness, name of the app, type of platform, type of occupational therapy intervention approach, and subdomain of cognition.Afterward, all information was analyzed and summarized (Tables 2-6).Due to the non-randomized controlled trials extracted in this study, a meta-analysis was not performed.

Study Quality Assessment
One researcher and one external expert conducted a qualitative evaluation of 18 studies in this study.The Physiotherapy Evidence Database (PEDro) scale and the Methodological Index for Nonrandomized Studies (MINORS) were applied to evaluate the qualitative level of the selected studies.The PEDro scale was used for randomized controlled trial studies, and the MINORS was used for nonrandomized controlled trial studies.Two reviewers assessed the evidence level of each qualitative evaluation tool.If the opinions of the two reviewers differed during the qualitative evaluation process, the final score was calculated by reaching an agreement through discussion.The PEDro scale is a valid measure of the methodological quality of clinical trials.It responds with 'Yes' or 'No', and the maximum score is 10 points (the number of 'Yes').A qualitative evaluation from a methodological perspective is conducted with 9-10 points being 'excellent', 6-8 points being 'good', 4-5 points being 'fair', and 4 points or less being 'poor' [20].We assessed the methodological quality of the retrospective articles using the MINORS score, with a global ideal score of 16 for non-comparative studies and 24 for comparative studies [21].We then determined the percentage of quality criteria met, i.e., below 25% (very low methodological quality), 25-49% (low quality), 50-74% (moderate quality), and above 75% (high quality).This method of categorizing continuous criteria has been previously reported [22].

Literature Search and Selection
The initial search retrieved a total of 331 studies.After excluding 33 duplicate studies, the remaining studies were evaluated based on the inclusion criteria.Consequently, 255 studies were excluded, and following the full-text evaluation of 43 studies, a further 25 studies were excluded.Finally, 18 studies were included in this study (Figure 1).

Study Quality Assessment
One researcher and one external expert conducted a qualitative evaluation of 18 studies in this study.The Physiotherapy Evidence Database (PEDro) scale and the Methodological Index for Nonrandomized Studies (MINORS) were applied to evaluate the qualitative level of the selected studies.The PEDro scale was used for randomized controlled trial studies, and the MINORS was used for nonrandomized controlled trial studies.Two reviewers assessed the evidence level of each qualitative evaluation tool.If the opinions of the two reviewers differed during the qualitative evaluation process, the final score was calculated by reaching an agreement through discussion.The PEDro scale is a valid measure of the methodological quality of clinical trials.It responds with 'Yes' or 'No', and the maximum score is 10 points (the number of 'Yes').A qualitative evaluation from a methodological perspective is conducted with 9-10 points being 'excellent', 6-8 points being 'good', 4-5 points being 'fair', and 4 points or less being 'poor' [20].We assessed the methodological quality of the retrospective articles using the MINORS score, with a global ideal score of 16 for non-comparative studies and 24 for comparative studies [21].We then determined the percentage of quality criteria met, i.e., below 25% (very low methodological quality), 25-49% (low quality), 50-74% (moderate quality), and above 75% (high quality).This method of categorizing continuous criteria has been previously reported [22].

Literature Search and Selection
The initial search retrieved a total of 331 studies.After excluding 33 duplicate studies, the remaining studies were evaluated based on the inclusion criteria.Consequently, 255 studies were excluded, and following the full-text evaluation of 43 studies, a further 25 studies were excluded.Finally, 18 studies were included in this study (Figure 1).

Study Quality Assessment
The PEDro scale was used for eight randomized controlled trial studies, and the MINORS scale was used for ten nonrandomized controlled trial studies.The PEDro scale scores of the eight studies ranged from five points (fair) to nine points (excellent).Seven of these studies, excluding one, demonstrated good or higher quality (Table 2).The MINORS scores of the ten studies ranged from 9 to 12 points out of a maximum of 16 points and from 15 to 18 points out of a maximum of 24 points.Most of the studies showed moderate to high quality (Table 3).

Intervention Type, Outcome Measurements, and Main Results of Studies
Table 5 shows the type of intervention, the number, frequency, and duration of sessions, outcome measures, main results, and correlation or effectiveness in cognitive function for 18 studies.Five studies [31,33,36,37,40] were applied only once to evaluate cognitive function rather than actual intervention application.Eleven studies presented the contents of interventions for the comparison group [23][24][25][26][27][28][29][30][31][32]34], with one study [32] applying the same interventions to both the experimental and comparison groups.
In analyzing the number of sessions, frequency, and period, the most common study design consisted of one session, as five studies [31,33,36,37,40] focused on evaluating the possibility of using apps for cognitive function evaluation purposes.Four studies [27,30,32,35] had a duration of four weeks; two studies lasted eight weeks [24,25] and six months [23,36], and one study each lasted ten weeks [34], twelve weeks [28], and sixteen weeks [29].One study [39] had an unknown period.The session duration ranged from the shortest at 15-20 min [25] to the longest at 90-120 min [35].Many studies did not report the session duration.
Of the sixteen studies, four [31,36,37,40] demonstrated the availability of cognitive function evaluation using apps; two [33,38] showed a significant correlation between mobile game scores and cognitive function; and two [32,39] demonstrated that mild cognitive impairment (MCI) can be effectively identified through app usage results.The remaining eight studies [23][24][25][28][29][30]34,35] correlated with cognitive function improvement using apps for cognitive function training.The improved cognitive functions included reasoning and language ability, memory, concentration, information processing speed, and problemsolving ability.

DailyCog app: smartphone application for the detection of mild cognitive impairment
There was no control group.Unknown Times that it took the users to perform tasks, Self-evaluation questionnaire (reflect the users' feelings on how they view their cognitive state and their functional abilities) The critical result of the study was the demonstration of the feasibility of using the DailyCog app for detecting and evaluating PD-MCI.

Mobile Applications Characteristics of Studies
Table 6 presents a comprehensive overview of the app's name, platform type, main cognitive rehabilitation objective, cognition subdomain, occupational therapy intervention approach type, and language for eighteen studies.It is worth noting that a diverse range of app types were utilized across all eighteen studies.The platform type varied, with three studies [23,28,34] using web-based mobile apps on PC, smartphone, or tablet, and the remaining fifteen studies employing general mobile apps on Android or iOS platforms.

Discussion
Recently, the popularity of cognitive training mobile apps has been increasing, but there is a lack of evidence for their effectiveness as digital therapeutics.Therefore, this study systematically reviewed the literature on the application of mobile applications for cognitive rehabilitation and evaluated their effectiveness.As an intervention for cognitive rehabilitation, this study included various occupational therapy approaches such as creating and promoting, establishing and restoring, maintaining, preventing, and modifying.A study that measured cognitive function was included to verify the effectiveness of mobile app applications.Although general characteristics such as age and gender of the study subjects were not limited, subjects whose cognitive impairment was not the main symptom but had mental illness or behavioral disorder as the main symptoms were excluded for suitability for the study.Cognitive disorders caused by neurological diseases are due to structural or functional brain damage.These diseases have a precise pathological mechanism, and related studies can increase the validity and reliability of the study by maintaining a consistent target group.This is consistent with previous studies emphasizing the importance of research on cognitive impairment based on neurological mechanisms [41].Mental illness and behavioral disorders are mainly associated with an imbalance of neurotransmitters or mental stress and have a different pathological mechanism than neurological diseases.Excluding these conditions avoids confusion in the research focus [42].Mental illness and behavioral disorders can be accompanied by cognitive decline, but this is mainly considered a secondary phenomenon.By limiting the study subject group to cognitive impairment due to neurological disease, we tried to increase the reliability of the study results [43].Additionally, the reason for including dementia and excluding schizophrenia is that dementia is a neurodegenerative disease with a direct pathological mechanism related to cognitive decline, while schizophrenia is a mental disease primarily associated with neurotransmitter imbalances and has different pathological mechanisms.By applying these criteria, we aimed to clarify the study's focus and maintain consistency and reliability.
Eighteen studies were finally analyzed; eight randomized control experimental studies [23][24][25][26][27][28][29][30] used the PEDro scale, and ten non-randomized control experimental studies [31-40] used MINORS.The PEDro scale validates the methodological quality of clinical trials [44].MINORS is the only valid quality assessment tool for non-randomized controlled trials [21].Six [23,[25][26][27][28]30] out of eight randomized control experimental studies met the quality criteria of Good, indicating that the study quality was high.In seven studies [23][24][25][26][28][29][30], excluding one [27], zero points were obtained in the therapist's blind item, and most studies scored low overall in the subjects', therapists', and assistants' blind items.This suggests that a blinded research design is required to improve the quality of future research.As a result of the quality evaluation of non-randomized control experimental studies using MINORS, three [32,36,37] out of ten met high quality criteria, and all seven met moderate quality criteria.Hence, the average quality evaluation results of the study were moderate.In particular, the overall low score was shown in the items of unbiased assessment of the study endpoint, follow-up period application to the aim of the study, and prospective calculation of the study size.To improve the quality of future research, blinding between the evaluator and the study subject is required when evaluating the measurement of research results.If blinding is impossible, the reason must be presented.Additionally, it is necessary to establish an appropriate follow-up observation period related to the research purpose and to plan the sample size sufficiently.
As a result of the general characteristic analysis of the eighteen studies, fourteen studies (77.77%) [25][26][27][28][29][30][33][34][35][36][37][38][39][40] were conducted over the past six years.Studies have been published in various journals, and the USA had the most research studies with six (33.33%) [26,30,[34][35][36]40].The target group included three studies [23,29,38] on healthy people, with study subjects' samples as high as 12,000 [38] and 6742 [23].The remaining studies involved subjects with cognitive disorders due to stroke, traumatic brain injury (TBI), mild cognitive impairment (MCI), multiple sclerosis (MS), and Parkinson's disease (PD), with sample sizes ranging from 3 to 104.Most of the studies were conducted on older adults (40s to 80s).The study results show that processing speed and cognitive mobile game scores decrease as age increases [38], cognitive function decreases as age increases, and the possibility of accompanying neurological diseases increases.Hence, most studies have researched older adults.This result indicates that it is essential to distinguish between age-related changes and disorders according to cognitive conditions, such as MCI, when designing cognitive training apps.Five studies [31,33,36,37,40] used only one session for cognitive function evaluation.Four studies [27,30,32,35] lasted four weeks; two studies lasted eight weeks [24,25] and six months [23,36], and one study each lasted ten weeks [33], twelve weeks [28], and sixteen weeks [29].The shortest application time of the intervention session was 15-20 min [25], and 90-120 min [35] was the longest.Many studies have not reported the application time.Healthy participants exhibited high frequency in intervention duration and session count, with 24 weeks [23], sixteen weeks [29], and 100 sessions [38].For multiple sclerosis with cognitive impairment, the intervention duration was eight weeks [24], post-brain injury with cognitive impairment was ten weeks [34], and dementia was four weeks [27,30].Comparing or generalizing research results is limited because the range of variables, such as the number of study subjects, study period, and session application time, is broad.Intervention duration is a crucial factor in determining the effectiveness of a study.Short intervention durations can be useful for analyzing the short-term effects of an app, but longer durations are necessary to confirm long-term effects.Intervention periods of more than six months have shown significant improvements in cognitive function [45,46].Several studies have demonstrated the effectiveness of cognitive rehabilitation apps in improving cognitive function in patients with mild cognitive impairment (MCI).According to a Cochrane review [47], at least twelve weeks of computer-based cognitive rehabilitation positively impact the maintenance and improvement of cognitive function.Long-term studies, such as those confirming the maintenance of effects twelve months post-intervention, are not just necessary but are significant in analyzing the effectiveness of cognitive rehabilitation apps [48].
Of the eighteen studies, fifteen used general mobile apps (smartphone or tablet), and the remaining three [23,28,34] used web-based mobile apps (PC, smartphone, or tablet).The main purpose of applying the cognitive rehabilitation apps analyzed was that thirteen (72.23%) studies focused on cognitive function training, and the remaining five (27.77%) [31,36,37,39,40] focused on cognitive function assessments.As a subdomain for cognitive function training or evaluation, memory showed the highest proportion with seventeen (94.44%) studies, followed by attention, executive function, speed of processing, listening, and visuospatial ability.Outcome measurements were most common, with five (27.77%) [25,27,28,31,33] studies applying the Mini-Mental State Examination (MMSE), a tool for screening overall cognitive function, followed by four (22.22%) [31,36,37,40] studies applying evaluation apps.In addition, various neurological evaluation tools were applied to evaluate cognitive function.According to the purpose of the study, instrumental activities of daily living (IADL), quality of life, depression, participation, behavioral and psychological symptoms of dementia (BPSD), and game scores were measured, showing significant differences [23,27,28,30,38].These results indicate the applicability of these indicators and cognitive function as indices to measure the effectiveness of intervention applications for cognitive rehabilitation.They will provide helpful information for future related research.This study categorized the characteristics of apps based on the titles and contents listed in the papers, sorting them by app name, platform type, application purpose, cognitive domain, intervention type, and language.The Mobile Application Rating Scale (MARS) is a widely used mHealth app quality assessment tool that includes multidimensional measurements of not only subjective app quality but also engagement, functionality, esthetics, and information [49,50].To apply the Mobile Application Rating Scale (MARS), it is necessary to directly execute and use the apps to evaluate detailed aspects such as engagement, functionality, esthetics, information, subjective quality, and app-specific items.However, there were significant limitations in directly executing the apps based solely on the information provided in the papers.Some studies provided partial screenshots, but issues such as the inability to find the apps in searches, improper execution, and lack of detailed program names were prevalent.Future studies aim to overcome data collection limitations based on papers by directly searching for and evaluating commercially available apps on platforms like the Google Play Store and Apple App Store using MARS.This approach is expected to enhance the reliability and validity of the MARS evaluations.Consequently, adopting this method will improve the quality of the research and provide more precise insights into the effectiveness and quality of mHealth apps.
As a result of applying the cognitive rehabilitation app, sixteen studies (88.88%) [23][24][25][28][29][30][31][32][33][34][35][36][37][38][39][40] showed positive clinical implications for the relationship or effectiveness of cognitive function.Among them, eight studies [23][24][25][28][29][30]34,35] demonstrated the correlation between using apps for cognitive function training and improving cognitive function.The main research results showed that the group that applied cognitive rehabilitation apps improved reasoning, language learning ability, and IADL performance [23] and showed improvement in verbal memory, delayed recall, fluency, concentration, and information processing speed, with long-term effects maintained even after six months [24].Additional improvements included problem-solving ability [34], working memory [25], IADL and daily memory, self-efficacy and life satisfaction [35], attention, executive function [28], executive function [29], prospective memory, and quality of life [30].Other studies have suggested that cognitive rehabilitation using mobile health apps can be effective for the elderly and patients with neurodegenerative diseases.In the study of Vaportzis et al. [51], the acceptability and usefulness of tablet training were high for the elderly.The study by Bier et al. [52] reported that even patients with cognitive impairment could apply the skills acquired during training to other smartphone and tablet functions in their daily lives.Four studies [31,36,37,40] demonstrated the possibility of using cognitive function evaluation using apps, and two studies [33,38] showed a significant correlation between mobile game scores and cognitive function.Two studies [32,39] demonstrated that mild cognitive impairment (MCI) could be effectively screened through the results of using apps.
On the other hand, two studies [26,27] did not show significant results in the effectiveness of applying mobile apps for cognitive rehabilitation.One [26] used veterans with TBI and PTSD symptoms, showing the possibility of improving emotional and behavioral control but not executive function.The other [27] applied digital reminiscence therapy to the elderly with dementia, which reduced depression and increased participation but showed no significant difference in cognitive functions and behavioral and psychological symptoms of dementia (BPSD).However, these results suggest that cognitive rehabilitation interventions for cognitive disabilities can consider not only cognitive function but also improving functions such as emotional and behavioral control, depression reduction, and participation.Cognitive dysfunction exhibits differentiated characteristics according to the general characteristics and the characteristics of the subject's disease, so the response to the cognitive training intervention will also differ [53].Therefore, it will be challenging to draw an accurate conclusion on the effectiveness of mobile apps in solving specific cognitive impairments if these differences are not considered.
According to the Occupational Therapy Practice Framework: Domain and Process (4th ed.) document published by the American Occupational Therapy Association [54], the occupational therapy intervention approach type of the cognitive rehabilitation mobile app used in the study was analyzed.All eighteen studies (100%) applied the prevention approach; fifteen studies (83.33%) [24][25][26][27][28][30][31][32][33][34][35][36][37]39,40] applied the establishment and restoration approach; and fourteen studies (77.77%) [23][24][25][26][27][28][29][30][32][33][34][35]38,39] applied the creation and promotion approach.It is thought that all studies applied the prevention approach because cognitive rehabilitation aims to prevent cognitive dysfunction and deterioration.Various studies have proven that cognitive rehabilitation apps are effective in improving cognitive function across diverse populations, suggesting that they may help prevent cognitive impairments.However, to strongly support these claims, long-term studies and additional clinical trials are required.The establishment and restoration approaches were likely prevalent due to the characteristics of the study subjects.Most studies targeted older adults with cognitive impairments due to neurological defects, so the app was used to establish and restore these cognitive impairments and prevent further deterioration.Additionally, since the mobile app was applied to evaluate cognitive function or verify the effectiveness of cognitive training in healthy adults, the creation and promotion approach was also applied [45].Cognitive rehabilitation apps can be effective in maintaining and improving cognitive function, but it is essential to manage side effects such as fatigue and addiction.Various studies suggest the following strategies to manage these factors effectively: It is essential to take adequate breaks between cognitive rehabilitation sessions and incorporate physical activity to reduce fatigue.Research indicates that physical activity can help reduce fatigue and improve cognitive function [55].Limiting the usage time of cognitive rehabilitation apps can prevent addiction; for instance, setting a limit on usage time per day is recommended [56].Monitoring the user's fatigue levels and usage patterns to create a personalized rehabilitation plan is effective.Cognitive rehabilitation professionals, such as occupational therapists, can support this approach by adjusting the rehabilitation activities to appropriate difficulty and frequency levels based on each individual's needs.
The app's target users may include individuals with Parkinson's disease, mild cognitive impairment (MCI), vascular dementia, Alzheimer's disease, cognitive impairment due to traumatic brain injury (TBI), and cognitive impairment due to multiple sclerosis (MS).It is essential to distinguish between these types of cognitive impairments associated with each condition and actively conduct research measuring the effectiveness of cognitive rehabilitation apps tailored to the characteristics of each disease.A systematic review and meta-analysis study on the effectiveness of cognitive rehabilitation programs for patients with Parkinson's disease [57] showed positive improvements in attention, working memory, verbal memory, executive function, and processing speed.The meta-analysis revealed moderate effects on overall cognitive status and working memory and minor effects on verbal memory, overall cognitive function, and executive function.However, minor effects were observed in attention, visual memory, verbal fluency, and processing speed, and no effects were found in visuospatial abilities.According to the study, these rehabilitation programs can improve cognitive skills in the short term, but the sustainability of these improvements remains unclear.MCI is an intermediate stage between normal aging and dementia, with memory decline as the primary symptom.MCI patients are at a higher risk of progressing to Alzheimer's disease, making early intervention crucial to maintaining or improving cognitive function.Cognitive rehabilitation programs for MCI patients have shown effectiveness in improving attention, memory, and executive function [58].These programs can help maintain cognitive function and slow the progression of Alzheimer's disease in the long term.Alzheimer's disease is a slowly progressing degenerative brain disorder where continuous cognitive stimulation is essential.Cognitive rehabilitation apps can provide regular and long-term cognitive stimulation, helping slow cognitive function decline.A meta-analysis of various clinical trials [59] concluded that cognitive rehabilitation improves daily functioning and quality of life in Alzheimer's patients.This analysis focused on improving overall cognitive function and task performance levels rather than specific cognitive functions.A pilot study targeting the Irish population [60] showed the positive impacts of cognitive rehabilitation on maintaining and enhancing cognitive function in early-stage Alzheimer's patients.The study found significant improvements in memory, attention, and executive function among patients who underwent cognitive rehabilitation.A review study [61] analyzed how various cognitive rehabilitation approaches contribute to the recovery of cognitive function and the enhancement of quality of life in TBI patients.The study emphasized improvements in major cognitive domains such as attention, memory, and executive function.Research utilizing computer-based cognitive rehabilitation programs for MS patients [55] showed significant improvements in cognitive function, particularly in attention and memory.These programs helped reduce the cognitive difficulties patients experienced in their daily lives.Based on the analysis of the effectiveness of cognitive rehabilitation applied to various diseases described above, further active research is needed to analyze the effectiveness of apps as digital therapeutics for cognitive rehabilitation.

Conclusions
This study systematically reviewed the literature on the use of mobile applications for cognitive rehabilitation and evaluated their effectiveness.Despite the growing interest in cognitive rehabilitation mobile applications, the evidence supporting their effectiveness remains limited.The broad range of variables, such as the number of study subjects, study duration, and session application time, presents challenges in generalizing and standardizing research findings.
To address these limitations, future research should focus on conducting well-designed randomized controlled trials (RCTs) that encompass diverse characteristics of cognitive impairment subjects and ensure sufficient sample sizes for statistically significant results.Additionally, long-term studies with appropriate follow-up periods are essential to verifying the sustained effectiveness of these interventions.
This study holds clinical significance by demonstrating the effectiveness of cognitive rehabilitation mobile applications from an occupational therapy perspective.The primary aim of cognitive rehabilitation-assessing the presence or absence of cognitive impairmentwas evaluated early in the intervention process.The applications were utilized to prevent and maintain cognitive function in healthy adults and to treat, maintain, and prevent further deterioration in individuals with cognitive impairments.
Our findings highlight the potential for cognitive rehabilitation mobile applications to be seamlessly integrated into daily life, thereby enhancing individual quality of life through prevention and treatment.These applications can increase accessibility to healthcare and ensure continuous expert management and support.By illustrating the strong connection between cognitive rehabilitation mobile applications and everyday activities, this study underscores the importance of these tools in real-life settings.
In conclusion, while this study provides promising evidence for the use of mobile applications in cognitive rehabilitation, further rigorous research is necessary to establish their efficacy and optimize their application.Long-term, well-structured studies are crucial to solidifying the role of cognitive rehabilitation mobile applications as effective digital therapeutics.

Figure 1 .
Figure 1.The PRISMA flow chart shows details of the processes related to the identification, screening, and selection processes.PICO = Participants, Interventions, Comparisons, Outcomes, Study design.

Figure 1 .
Figure 1.The PRISMA flow chart shows details of the processes related to the identification, screening, and selection processes.PICO = Participants, Interventions, Comparisons, Outcomes, Study design.

Table 1 .
Keywords related to cognition, mobile app-based cognitive rehabilitation, cognitive function.

Table 4 .
General characteristics of studies.

Table 5 .
Intervention type, outcome measurements, and main results of studies.

Table 6 .
Mobile application characteristics of studies.